REPORT ON HOSPITAL TRAINING

In Partial Fulfillment of Requirement for Award for Degree

Of

Bachelor of Pharmacy B
y

RAHUL KUMAR CHAURASIA

Roll No. – 1903150500064

Under supervision

Dr. ANIL KUMAR SINGH

Associate Professor United Institute of

Pharmacy Naini, Prayagraj

Faculty of Pharmacy
UNITED INSTITUE OF PHARMACY 1
 DR. A.P.J. ABDUL KALAM TECHNICAL UNIVERSITY
2021-22

DECALARATION

I hereby declare that the project report entitled “Hospital Training”

was empirical finding and this report is based on information collected
and carried by me. I did not copy anything from the reports earlier.
All the information in this report is given by me by the different section
s of the Hospital.

DATE 28/01/2022

PLACE BHATNI -DEORIA

RAHUL KUMAR CHAURASIA (1903150500064)

UNITED INSTITUE OF PHARMACY 3
 ACKNOWLEDGMENT
This report embodies the overview of the C.H.C. BHATNI DEORIA
HOSPITAL. I owe my deep sense of gratitude of Almighty
God, for his blessings that made it possible for me to complete my traini
ng. I feel immense pleasure to show my gratitude towards RAJENDRA
PRASAD (Chief pharmacist) under whom I had completed my hospita
l training of 150 hours. He has provided me all the necessary informatio
n which, I should know during this period.

I am thankful to Prof. (Dr.) Alok Mukherjee and Dr. Anil Kumar Sin
gh who has guided me and told me how it will be beneficial for me in m
y future. I am also thankful to all the faculty members for letting aware a
bout the hospitals and the various theories on it. I wish to thank my pare
nts for their undivided support who inspired and encouraged me to go m
y own way. Without them, I would have been unable to complete my trai
ning. At last I want to thank my friends who appreciated me for helping
me during this training in all possible ways and motivating me.

So, my heartiest thank you to all who guided me helped me with all they
could do for me.

RAHUL KUMAR CHAURASIA

1903150500064

Thanking You.

Index
S.No. Content Page No.
1 Introduction 08
2 Hospital Pharmacy 09-10
3 Prescription Monitoring 11
4 Medication Errors & Adverse Drug Reaction Reporting 12
5 Patient Education & Counseling Including Achieving Concordance 13-14
6 Pharmacokinetics & Therapeutic Drug level Monitoring 15
7 The role of Pharmacy Technicians in Clinical Pharmacy Services 16
8 Infrastructure 17
9 General Ward 17
10 Surgical Ward 18
11 Emergency Ward 18
12 Role and responsibility of Hospital Pharmacist 19-21

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 13 Conclusion 22

INTRODUCTION

In order to widen my knowledge, to have new experience

s in the field of health care, did training at C.H.C.
BHATANI DEORIA.
This training course is extended over a period of 150 hours,
beginning on 28 JAN 2022.
C.H.C.BHATNI DEORIA.
OBJECTIVES OF THE INTERNSHIP-
I. Observing comparing, analyzing and commenting on th
e management of different pathologies, clinical and par
aclinical approaches.
II. Integrate fully the family medicine service (go to the ext
ended clinic, the ward, the emergency room), participat
e in the activities of the other services.
III. Observation of procedures.
IV. Rotations in family medicine, internal medicine, pediatr
ics, obstetrics and gynecology, surgery, especially pedia
tric and adult emergencies.

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UNITED INSTITUE OF PHARMACY Page 8

HOSPITAL PHARMACY
The practice of pharmacy within the hospital under the supervision of a profession
al pharmacist is known as hospital pharmacy.

FUNCTIONS OF HOSPITAL PHARMACY:

• Forecast of demand.
• Selection of reliable suppliers.
• Prescribing specifications of the required medicament.
• Manufacturing of sterile or non-sterile preparations.
• Maintenance of manufacturing records Quality control of purchased or manu
factured products.
• Distribution of medicaments in the wards.
• Dispensing of medicaments of out-patients.
• Drug information sources in hospitals.
• Centre for drug utilization studies.
• Implement recommendations of the pharmacy and therapeutic committee.
• Patient counseling.

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 • Maintaining liaison between medical, nursing and the patient.

OBJECTIVES OF HOSPITAL PHARMACY

1. To professionalize the functioning of the pharmaceutical services in hospital
s.
2. To ensure availability of the required medication at an affordable cost at the
required time.
3. To plan, organize and implement the policies of the pharmacy.
4. To perform functions of management of material, purchase, storage of essent
ial items.
5. To maintain strict inventory of all items received and issued.
6. To counsel the patient, medical staff, nurses and others involved in patient ca
re on the use of drugs, possible side effects, toxicity, adverse effects, drug int
eractions etc.
7. To serve as a source of information on drug utilization.

Page

8. To manufacture drug, large/small volume parenterals which are critical for u

se in patients.
9. To participate in and implement the decisions of the pharmacy and therapeut
ics committee.
10.To organize and participate in research programmers, educational programm
ers.
11.To provide training to various members of the patient team on various aspect
s of drug action, administration and usage.
12.To engage in public health activities to improve the well-being of the popula
tion.
13.To interact, cooperate and coordinate with various other departments of the h
ospital.
 .

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 PRESCRIPTION MONITORING
The core of pharmacists’ contribution to appropriate prescribing and medication us
e is made whilst undertaking near-patient clinical pharmacy activities.

Checking and monitoring patients’, prescriptions on hospital wards is frequently the

starting point for this process and on most hospital wards the prescription card and
clinical observation charts (temperature, pulse rate, blood pressure, and so on) are t
ypically kept at the end of the patient’s bed. This allows the clinical pharmacist to i
nteract with the patient whilst reviewing the contents of the prescription. The prescr
iption is reviewed for medication dosing errors, appropriateness of administration r
oute, drug interactions, prescription ambiguities, inappropriate prescribing and man
y other potential problems. Formal assessments of prescription charts in hospitals h
ave shown that there are wide variations in the quality of prescribing and pharmacis
ts are able to identify and resolve many clinical problems. Patients can be questione
d on their medication histories, including allergies and intolerances, efficacy of pres
cribed treatment, side-effects and adverse drug reactions (ADRs).

The routine presence of medical and nursing staff on the ward allows the pharmacis
t to communicate easily with other member so the healthcare team who value the pr
escription-monitoring service that clinical pharmacists provide. 19, 20 Patients’ not
es are also accessible, to enable the pharmacist both to check important information
that may affect their healthcare and to record details of any clinical pharmacy input
made.

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 MEDICATION ERRORS & ADVERSE
DRUGREACTION REPORTING
Despite the important role of clinical pharmacy services, patients receiving drug the
rapy may still experience unintended harm or injury as a result of medication errors
of from ADRs. Adverse events (from any cause) occur in around 10% of all hospita
l admissions and medication errors account for one quarter of all the incidents that t
hreaten patient safety.

A study commissioned by the General Medical Council identified a mean prescribi

ng error rate of 8.9 per 100 medication orders. Contributing to the avoidance or res
olution of adverse medication events is an important part of any hospital pharmacis
t’s clinical duties. This requires a multisystem approach, often incorporated into a h
ospital’s clinical risk management strategy. Important lessons can be learned from a
nalysis of medication-related incidents and from near-misses (that is, those that do

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not develop sufficiently to result in patient harm or are detected prior to patient har
m).

Even when the prescribed and administered treatment is correct and no errors have
occurred, a small proportion of patients can still suffer from ADRs. Clinical pharma
cists have an important role to play in the detection and management of ADRs and,
more recently, directly reporting ADRs to the Committee on Safety of Medicines vi
a the Yellow Card scheme. Their involvement can help to increase the number of A
DR reports made, particularly those involving serious reaction.

PATIENT EDUCATION &

COUNSELLING,INCLUDING ACHIEVING
CONCORDANCE
One of the key themes of the 2010 White Paper is empowering patients to take an a
ctive role in managing their own care. This is also one of the themes of many of the
NHS-National Institute for Health Research collaborations for leadership in applied
health research and care that focus on translating research into practice. Helping pat
ients to understand their medicines and how to take them is a major feature of clinic
al pharmacy. Patient compliance, defined as adherence to the regimen of treatment
recommended by the doctor, has been a concern of healthcare professionals for som
e time. Adherence to treatment, particularly for long-term chronic conditions, can b
e poor and tends to worsen as the number of medicines and complexity of treatment
regimens increase. NICE notes that between a third and half of all medicines prescr
ibed for long-term conditions are not taken as recommended and estimated that the
cost of admissions resulting from patients not taking medicines as recommended w
as between @36 million and @196 million in 2006-2007.

In recent years, use of the term ‘compliance’ in the context of medication has been
criticized because it implied that patients must simply follow the doctor’s orders, ra
ther than making property informed decisions about their healthcare. The term ‘con
cordance’ has been proposed as a more appropriate description of the situation.

Concordance is a new approach to the prescribing and taking of medicines. It is an

agreement reached after negotiation between a patient and healthcare professional t
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hat respects the beliefs and wishes of the patient in determining whether, when and
how medicines are taken.

This change in approach helps optimize the benefits of treatment by helping patient
s and clinicians collaborate in a therapeutic partnership.However, if patients are to
make informed choices, then the need for comprehensive patient education become
s more pressing.

Concordance with treatment is dependent on a complex interplay of beliefs, trust an

d understanding, with non-adherence falling into two overlapping categories:

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 1. Intentional: the patient decides not to follow the treatment recommendations.
2. Unintentional: the patient wants to follow the treatment recommendations, but
practical problem prevent the patient from doing so.

Many surveys have found that patients often know little about the medicines they a
re taking. Several studies examining patient counseling and education have shown
that clinical pharmacists can help to improve patients’ knowledge of their treatmen
t. The contribution made can also improve patient adherence to treatment. Improve
d adherence should lead to improved outcomes and evidence has been collected to
demonstrate this.

In addition to providing face-to-face education and counseling on medicines, clinic

al pharmacists can also help patients by contributing to the preparation of written
material and audiovisual demonstrations, or by using computer programs.

How patients take their medicines is a crucial component of whether the desired ou
tcomes will be achieved. Key to this is the health beliefs of individuals and the rela
tionship with their healthcare providers that are necessary in order to ensure this ha
ppens. Society is moving away from a paternalistic approach to healthcare to a mor
e empowered one. Thus, whereas a course of treatment used to be accepted obedie
ntly by patients, treatment is now negotiated and options, risks and benefits are dis
cussed and, where necessary, consent is obtained. Thus there is a greater need for i
nformation and education of patients and/or careers in order for them to be able to
make informed decisions about their treatment. Indeed, the 2010 White Paper emp
hasized the importance of patient involvement, and included the phrase ‘nothing ab
out me, without me’.

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 PHARMACOKINETICS &
THERAPEUTICDRUG LEVEL
MONITORING
Pharmacokinetics addresses the absorption, distribution, metabolism and excretion
of drugs in patients. A sound knowledge of the pharmacokinetic profiles of differe
nt drugs enables the pharmacist to assess the dosing requirements for certain drugs
in patients in extremes of age and in the presence of impairment of kidney and live
r function. Clinically important drug interactions and adverse reactions can someti
mes be predicted. Dosing calculations of amino glycoside antibiotics are us usually
made by employing pharmacokinetic principles.

A number of medicines in common use have a narrow therapeutic index; that is, th
e difference between the lowest effective dose and a potentially toxic dose can be q
uite small. In many cases it is necessary or desirable to undertake therapeutic drug
level monitoring (TDM) to ensure that patients can be treated safely. TDM service
s include the measurement of drug level in the patient’s blood and the application o
f clinical pharmacokinetics to optimize drug therapy.

This is a wide range of medicines that fall into this category, but TDM services typ
ically include amino glycoside antibiotics, anticonvulsants,
immunosuppressant’s, dioxin, lithium and theophylline. Monitoring drug levels in
patients can also provide an important indicator as to whether they are taking their
medicine. Clinical pharmacy input into TDM services can range from the provisio
n of simple advice to other clinicians on when to take samples and how to interpret
results, to fully fledged services that may include collection and laboratory analysi
s of the blood sample.

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 Page

THE ROLE OF PHARMACY

TECHNICIANSIN CLINICAL PHARMACY
SERVICES
The role of pharmacy technicians is already well established in departmental activit
ies such as dispensing and aseptic services. However, the expansion of clinical pha
rmacy services in hospital would not be possible without the additional support tha
t can be provided by hospital pharmacy technicians.

In a similar manner to the way in which ward pharmacy services provided by phar
macists evolved into clinical pharmacy, pharmacy technicians’ role are becoming i
ncreasingly clinical in nature and can include a wide range of activities.

Current activities undertaken by pharmacy technicians, in collaboration with phar

macists, include:

• Medication supply
• Checking medication in POD schemes
• Patient counseling and education, including the provision of patient aids whe
re appropriate, as well as medication charts and monitored-dose systems to a
id compliance
• Supporting patient’s self-medication
• Medicines information
• Discharge planning for patients, including communication with primary care
colleagues where appropriate
• Involvement in clinical trials and good clinical practice governance
• Preparation of medicines formularies and guidelines
• Training and education
• Liaison with clinical teams on medicines management and expenditure
• AMS.
The importance of AMS is highlighted in national reports and is enshrined within s
tatute in the Health and Social Care Act 2008.

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Guidance for compliance with criterion 9 states that healthcare providers ‘have and
adhere to policies, designed for the individual’s care and provider organizations th
at will help to prevent and control infections’.

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 INFRASTRUCTURE
1. Located in the ground floor or in the first floor.
2. Sufficient space for seating of patients.
3. Waiting room for out-patients. It should contain educative posters on hea
lth, hygiene and offer literature for reading.
4. Suitable space-routine manufacturing of bulk preparations (stock solution
s, bulk powders and ointments etc).
5. Office of the chief
6. Packaging and labeling area
7. Cold storage area
8. Research wing
9. Pharmacy store room
10. Library
11. Radio isotope storage and dispensing area.

GENERAL WARDS-General ward is a common unit where patients who a

re admitted share the same room. The ward is equipped with health monitoring
systems with one-to-one care assistance for patients as required. Facilities are c
atered as per patient's diagnosis, age, comfort and other essential factors.

SURGICAL WARDS-When the person is judged to have recovered from the

anesthesia, he/she is either transferred to a surgical ward elsewhere in the hospital
or discharged home. During the post-operative period, the person's general functio

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n is assessed, the outcome of the procedure is assessed, and the surgical site is che
cked for signs of infection.

EMERGENCY WARDS- An emergency department, also known as an ac

cident & emergency department, emergency room, emergency ward or casualty
department, is a medical treatment facility specializing in emergency medicine,
the acute care of patients who present without prior appointment; either by their
own means or by that of an ambulance.

ROLE AND RESPONSIBILITIES

OFHOSPITAL PHARMACIST

INDOOR PHARMACISTS RESPONSIBILITIES

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a) Central dispensing area:

1. To ensure that all drugs are stored and dispensed correctly.

2. To check the accuracy of the dosages prepared.
3. Maintain proper records
4. Preparation of bills
5. Co-ordinate over all pharmaceutical needs of the patient
6. Framed policies and procedures are followed
7. Maintain professional competence
8. Communicate with all pharmacy staffs

b) Patient care areas:

1. Maintain liaison with nurses

2. Reviewing of drug administration
3. Provide instruction and assistance to the junior pharmacist.
c) Direct patient areas:

1. Identification of drugs brought into the hospital

2. Obtaining patients medication history
3. Assist in the selection of drug products
4. Monitor patients total drug therapy
5. Counseling patients
6. Participating in cardio-pulmonary emergencies

d) General responsibilities:

1. Ensure that all drugs are handled properly

2. Participate in cardio-pulmonary emergencies
3. Provide education and training for pharmacists.

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OUTDOOR PHARMACIST RESNSIBILITIES :
a) Central dispensing area:

1. To ensure that all drugs are stored and dispensed correctly.

2. To check the accuracy of the dosages prepared.
3. Maintain proper records.
4. Preparation of bills
5. Keeps the pharmacy neat and tidy manner

b) Patient care areas

1. Inspect periodically the medication areas

2. Identify the drug brought into the hospital
3. Monitoring of drugs
4. Counsel the patients

c) General responsibilities:

1. Ensure that all drugs are handled properly

2. Participate in cardio-pulmonary emergencies
3. Provide education and training for pharmacists
4. Co-ordinate overall pharmaceutical need of the outdoor services

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 CONCLUSION
To do the practical training in a retail pharmacy is nothing but utilizing and imple
menting whatever knowledge gained during course. Every student trainee should d
o systemic training during practical training period. This proforma will beneficial t
o all institutes of pharmacy for uniformity in project and training before sanctionin
g the apprentice practical training.

In fact, I spent an excellent 150 hour internship, I learned a lot, Observed, Noted, I
dentified, Discussed… I am sure that this information will be useful to me through
out my professional career.

While allowing me better apprehend and manage diseases, and thus serve my count
ry, I shall also transmit them to my successors.

I am satisfied with the internship, and my objectives are reached at 80%, and I than
k once again all those who have contributed to this success.

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